I am a physician and behavioral scientist at Duke University. My research and writing explores the quirks in human nature that influence our lives — the mixture of rational and irrational forces that affect our health, our happiness and the way our society functions. (What fun would it be to tackle just the easy problems?) I am currently exploring controversial issues about the role of values and preferences in health care decision making, from decisions at the bedside to policy decisions. I use the tools of decision psychology and behavioral economics to explore topics like informed consent, shared decision making and health care spending. My books include Pricing Life (MIT Press 2000) and Free Market Madness (Harvard Business Press, 2009). My newest book, Critical Decisions (HarperCollins), explores the challenges of shared decision making between doctors and patients.

Lifesaving Lessons from the Makers of Sprite?

It was the late 90s and HIV was spreading through South African teenagers like, well, like a sexually transmitted disease. Sleep with a South African at that time and you faced a one in six chance of having a close encounter with the virus. Frightening odds. But not frightening enough to curb teenage sexual activities.

Desperate to turn the tide, public health leaders came up with a new anti-HIV campaign: NASHI, for the National Adolescent Sexual Health Initiative. Personally, I think they should have called it ESTINA for Every South African Teenager is Now Asleep. Because that campaign, like so many public health campaigns, was doomed to fail. It was all information, and no persuasion. All lecture, no fun.

Fortunately, Judi Nwokedi had a different idea. A psychologist who had recently moved back to South Africa, she had recently decided to run a campaign modeled on the successful relaunch of Sprite into the South African market. As described in Tina Rosenberg’s excellent book Join the Club, Nwokedi noticed that Sprite was less focused on informing consumers about the characteristics of its product – fresh taste! Lemon lime accents! – than on creating a sense of community, where Sprite’s brand would be associated with fun and cool activities. As Rosenberg quotes Nwokedi:

So she created the LoveLife Program. They posted billboards with slogans like “Get Attitude!” They published magazines on websites that focused as much, maybe more, on fashion than on HIV. Parents thought this campaign was awful. It wasted too much time on non-educational activities, in their humble opinions. But kids thought otherwise. This LoveLife thing looked like a group they wanted to be part of!

Too often, in trying to help people make better decisions in life, we health experts focus on information – on facts and figures. But information is just the starting point. People are rarely motivated by facts and figures alone, a topic I discuss in some detail in my recent book Critical Decisions. What person doesn’t know that a double whopper is bad for his waistline? What smoker doesn’t know that a pack a day of Marlboro’s is bad for his lungs, heart, and [insert your favorite internal organ here]?

For facts to motivate, they need to feel relevant and immediate.. And what motivates kids more than peer pressure?

LoveLife succeeded in part by putting most of the “messaging” into the hands of teenage peers, and by not worrying about how frequently or vehemently pushed the message. One teenager summarized the program succinctly:

Seeing billboards of a dying person didn’t tell me about me. But when someone says “You have such amazing potential that HIV shouldn’t be part of it” – then it wasn’t about HIV. It was about me.

As someone trained in both medicine and behavioral economics, I’ve thought a lot about how to best “nudge” people towards healthier behaviors, without restricting their freedom to choose for themselves. The success of LoveLife serves to remind me that efforts to help people improve their health and well-being should not focus solely on providing folks with the facts. They all need to feel that the facts “are about me”!

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